右美托咪定滴鼻与水合氯醛口服对小儿中深度镇静效果比较的Meta分析

Comparison of intranasal dexmedetomidine and oral chloral hydrate administration for deep sedation in children: a meta-analysis

目的采用Meta分析的方法评价右美托咪定滴鼻与水合氯醛口服在小儿中深度镇静中的效果。方法计算机检索Pubmed、EMBase、CENTRAL(2018年4期)、Web of Science、中国生物医学文献数据库(CBM)、万方数据、中国知网和维普数据库,检索时间均为建库至2019年1月5日,纳入小儿中深度镇静过程中以右美托咪定滴鼻与水合氯醛口服作为干预方法的随机对照研究(RCT),比较两种方法的中深度镇静成功概率、镇静起效时间和苏醒时间、呕吐和窦性心动过缓发生率。数据采用RevMan 5.3和Stata 12.0软件进行Meta分析。结果共纳入7项RCTs,1007例患儿。结果显示右美托咪定滴鼻组中深度镇静的成功率、窦性心动过缓的发生率均高于水合氯醛口服组(OR=2.55,95%CI:1.46~4.44,P<0.01;OR=4.42,95%CI:1.82~10.74,P<0.01);右美托咪定滴鼻组镇静后恢复时间、呕吐发生率均低于水合氯醛口服组(MD=-16.41,95%CI:-21.54^-11.28,P<0.01;OR=0.04,95%CI:0.01~0.17,P<0.01);而镇静起效时间指标两组比较差异无统计学意义(MD=-0.47,95%CI:-2.71~1.22,P=0.46)。结论右美托咪定滴鼻较传统的水合氯醛口服相比具有较高的镇静成功率,而且镇静后恢复快,呕吐发生率低。

Objective To compare the effect of intranasal dexmedetomidine and oral chloral hydrate in deep sedation of children.Methods The Pubmed,EMBase,CENTRAL(Issue 4,2018),Web of science,CBM,Wanfang Data,CNKI and VIP databases from the inception to January 2019 were searched.Randomized controlled trials(RCTs)with dexmedetomidine and chloral hydrate as interventions were included and the data were analyzed by RevMam 5.3 and Stata 12.0 software.The success rate of deep sedation,the indicator of sedation onset time,the recovery time,the incidence of vomiting and bradycardia were compared.Results A total of 7 RCTs involving 1007 patients were included for analysis.The results showed that the success rate of deep sedation(OR=2.55,95%CI:1.46-4.44,P<0.01)and the incidence of bradycardia(OR=4.42,95%CI:1.82-10.74,P<0.01)in the dexmedetomidine nasal group were significantly higher than those in the chloral hydrate oral group.The recovery time was significantly shorter(MD=-16.41,95%CI:-21.54-11.28,P<0.01)and the incidence rate of vomiting(OR=0.04,95%CI:0.01-0.17,P<0.01)in dexmedetomidine nasal group was significantly lower than those in the chloral hydrate oral group.There was no significant difference in the indicator of sedation onset time(MD=-0.47,95%CI:-2.71-1.22,P=0.46).Conclusion Compared with the traditional oral chloral hydrate,intranasal dexmedetomidine has a higher sedation success rate and shorter recovery time after sedation with a lower incidence of nausea and vomiting.